Entamoeba histolytica in urine: a case report

Background: Entamoeba histolytica is an anaerobic protozoan parasite predominantly affecting the gastrointestinal tract but capable of systemic dissemination to organs such as the liver and lungs. Detection of Entamoeba histolytica in urine is an exceptionally rare occurrence, typically associated with severe or invasive forms of amoebiasis. Case Report: we report a case of a 17-year-old female patient who presented with dysuria, suprapubic pain, and hematuria. Urine microscopy demonstrated spherical cysts (~15 µm in diameter) morphologically consistent with Entamoeba histolytica, containing intracytoplasmic erythrocytes. The diagnosis was confirmed by stool analysis and serological testing. Abdominal ultrasonography revealed mild bladder wall thickening, with no evidence of hepatic abscess or other extraintestinal involvement. The patient had no history of surgical interventions. Treatment with metronidazole followed by paromomycin achieved complete resolution of symptoms, confirming therapeutic success. Conclusions: identification of Entamoeba histolytica in urine, although uncommon, is clinically significant and necessitates awareness of atypical presentations. This case emphasizes the importance of integrating parasitological, serological and imaging tools for timely diagnosis and management of extraintestinal amoebiasis.